# Informed Consent in Shoulder and Elbow Surgery

## TL;DR

This paper reviews informed consent practices in shoulder and elbow surgery, highlighting challenges and strategies to improve patient communication and understanding.

## Contribution

The paper provides a comprehensive synthesis of barriers and solutions for informed consent in shoulder and elbow surgery, emphasizing patient-centered approaches.

## Key findings

- Limited quantitative data on consent quality exists despite high malpractice rates in shoulder and elbow surgery.
- Barriers to effective consent include low health literacy, language discordance, and insufficient physician training.
- Proposed solutions include teach-back methods, plain-language explanations, and structured resident training.

## Abstract

Informed consent is essential for patient autonomy and shared decision-making but remains inconsistent in orthopaedic surgery. Shoulder and elbow procedures present unique challenges, with complex functional outcomes, diverse patient demographics, and high medicolegal exposure. Despite the clinical and legal importance of informed consent, evidence describing current practices in this subspecialty is limited. This review aimed to synthesize the literature on consent in shoulder and elbow surgery, identify barriers to effective communication, and highlight strategies to improve patient understanding and engagement. Peer-reviewed literature was identified through searches of PubMed, Web of Science, and Scopus from database inception through September 11, 2025. Eligible studies addressed informed consent in shoulder and elbow surgery, including consent quality, patient comprehension, expectations, communication interventions, or medicolegal outcomes. Studies not directly addressing informed consent in this context were excluded. Findings reveal limited quantitative data on consent quality, despite high malpractice rates and frequent citation of inadequate consent in litigation. Key barriers include low health literacy, language discordance, insufficient physician training, and time constraints. Patient expectations vary by occupation, gender, and age, emphasizing the need for individualized consent discussions. Proposed solutions emphasize multifaceted, patient-centered approaches: the teach-back method to confirm comprehension, plain-language explanations supported by visual aids, structured resident training to improve communication, timely access to professional interpreter services, and greater workforce diversity to strengthen rapport. Future research should focus on validating specialty-specific consent frameworks, integrating digital adjuncts such as videos or surgery-specific forms, and adopting quantitative outcome measures to evaluate effectiveness. System-wide implementation of these strategies could enhance autonomy, build trust, reduce medicolegal risk, and improve outcomes in shoulder and elbow surgery.